World Health Organization 20, Avenue Appia

Box 1. Core values for PHC include:
n
equity
n
social justice
n
universality
n
people-centredness
n
community protection
n
participation
n
scientific soundness
n
personal responsibility
n
self-determination
n
self-reliance
Source: Adapted from WHO Regional Office for the Western Pacific (2010) (20).

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15
A WHO guide for planners, implementers and managers
Overcoming fragmentation in health care services through 
integration
According to the first global monitoring report on UHC, at least 400 million people lack access to one or 
more essential health services 
(22). This is due largely to a focus in public health systems on expensive, 
vertical, disease-specific prevention and treatment programmes, to insufficient allocation of resources to 
PHC (including community-based palliative care) and to lack of integration between vertical programmes 
and PHC 
(23). With the ageing of populations and the growing burden of long-term chronic illness and 
multiple morbidities, fragmented health care systems can no longer cope effectively with rising demands for 
care. These illnesses include not only cancer and major organ failure, but also HIV/AIDS and mental health 
conditions such as substance use disorders, depression and dementia. Disease treatment and palliative 
care should be integrated at all levels of health care systems. Mechanisms to ensure smooth transitions 
and continuity of care between various levels of health care systems, such as between hospital and home 
care, should be put in place for all patients, including those receiving curative treatment, chronic disease 
management, palliative care, and any combination of these. Integrated, accessible, people-centred PHC 
has been enhanced in some countries with intersectoral integration of social services such as housing, 
employment, family welfare and disability support programmes 
(24). Attention to the social determinants 
of ill health, and responding to social suffering with programmes such as these, are fundamental both to 
PHC and to palliative care and reveal their interfusion 
(7,25).